What can a vestibular assessment answer?
The inner ears, eyes, brain, sensation, muscles, heart rhythm, blood pressure, medicines, and migraine can all affect balance. A planned set of tests can show which parts of the vestibular system it measured and what else needs checking.
Inner ear
Is one ear or one pathway responding differently?
Calorics, vHIT, VEMP, and rotary chair examine different parts of vestibular function.
Eyes and position
What happens to the eyes during visual or positional tasks?
VNG can record nystagmus and eye tracking patterns under controlled conditions.
Function
How does the person use vision, sensation, and vestibular input?
Posturography and gait assessment can show functional balance limits without naming the cause alone.
The assessment does not cover every cause of dizziness. A stroke or heart problem needs separate checks. One number cannot prove vestibular migraine. Brain fog also needs the attack history and a wider exam.
Save this test
Save the balance results, symptoms, and clinician's plan
Keep episode history, tests, sides, canals, numbers, symptoms, quality limits, and the next plan together in My Fog.
My Fog does not interpret eye movements, diagnose vestibular disease or stroke, or choose maneuvers, rehabilitation, medicines, or imaging.
Who needs a different vestibular testing plan?
Age, neck movement, hearing, vision, pregnancy, fall risk, medicines, and ability to follow instructions can change the test battery.
Babies and children
Use pediatric audiology or vestibular services. Tests and norms depend on age, development, hearing loss, attention, head control, and tolerance. A two-center study found vestibular loss in 44% of selected children with sensorineural hearing loss, not in children generally.
Adult women and men
There is no general female or male pass cutoff. Migraine, hearing history, medicines, neck movement, vision, neuropathy, blood pressure, and the attack details often matter more than sex alone.
Pregnancy and after birth
Tell the service before medicine changes, fasting, calorics, or strongly provocative tests. Dizziness with bleeding, chest pain, breathlessness, severe headache, weakness, or marked swelling needs direct maternity or emergency advice.
Older adults and people at fall risk
Vision, neuropathy, strength, medicines, blood pressure, cognition, and hearing can combine with vestibular loss. Ask for transfer help, a safety harness for platform testing, recovery time, and a transport plan.
What should you do before vestibular testing?
Ask which tests you'll have: hearing, VNG or ENG, positional testing, calorics, vHIT, VEMP, rotary chair, posturography, gait, or another examination.
Follow the center's food, alcohol, caffeine, nicotine, makeup, contact-lens, sleep, and medicine instructions. Do not stop a sedative, antihistamine, antidepressant, anti-nausea medicine, seizure medicine, or other prescription unless the ordering clinician gives a safe plan.
Bring a complete medicine list and say when you took the last dose. Medicines may affect eye movements or symptoms, but withdrawal can also be unsafe.
Describe two typical episodes: the first sensation, trigger, head or body position, duration, hearing change, tinnitus, ear fullness, headache, visual aura, nausea, faintness, weakness, and recovery.
Arrange transport if the center warns that testing may provoke vertigo or if your medicines changed. Ask about fall support, mobility, neck limits, vision, hearing, interpreter, sensory, and caregiver needs.
Begin with the episode history
The clinician reviews timing, triggers, hearing, migraine, neurological symptoms, falls, medicines, and cardiovascular features before choosing tests.
Check hearing and eye movements
Audiometry and VNG or ENG can show hearing patterns, spontaneous nystagmus, visual tracking, and positional responses.
Test different parts at different speeds
Calorics, vHIT, and rotary chair do not measure the same stimulus or frequency. A difference between them can be meaningful.
Assess otolith and standing function when needed
VEMP can test sound- or vibration-linked muscle responses. Posturography tests balance under changing sensory conditions.
Recover before leaving
Tell staff if symptoms remain strong. Follow the center's advice about walking, driving, work, and help at home.
How should you read vestibular test results?
Start with the tests performed and the medicines taken, then read each side, organ, speed, quality limit, symptom, and specialist interpretation.
No important abnormality in the tested pathways
No important abnormality on the parts of the system that this battery measured
This narrows the question but does not rule out intermittent BPPV, vestibular migraine, central disease, orthostatic problems, medicines, vision, neuropathy, or another untested pathway.
A small, inconsistent, or limited finding
Small asymmetry, threshold-near value, inconsistent response, or technical limit
Check calibration, alertness, vision, ear status, neck movement, medicines, age, device norms, and whether another test measures the same pathway differently.
A peripheral vestibular problem
Tests found a peripheral vestibular problem
The report should name the side, organ or canal, degree, compensation, hearing context, and whether rehabilitation, a positional maneuver, imaging, or medical review is appropriate.
A brain, hearing, or urgent problem
Tests found a brain, hearing, severe fall-risk, or neurological problem
Follow the specialist's timing. Sudden severe vertigo with weakness, speech trouble, double vision, inability to walk, or severe new headache needs urgent assessment.
A normal result on one test does not rule out problems in other parts of the balance system.
vHIT, calorics, VEMP, rotary chair, positional testing, and posturography ask different questions.
See research details
These checks explain why a battery is used, why vHIT and calorics can disagree, current device-specific ranges, and a 2025 disease-comparison meta-analysis.
Ask which organ, pathway, speed, or real-life function each test actually measured.
When the clinical question needs both tests, keep both results, including the less reassuring one.
Use the laboratory's device, canal, age, calibration, artifact, and saccade rules. The 0.70 value isn't a universal cutoff.
Read the results alongside attack history, hearing, migraine features, examination, and specialist criteria.
What can you do now?
Make the episodes easier to recognize and reduce fall risk while you wait for the result.
Describe two attacks in order
Record the first sensation, trigger, duration, hearing, headache, vision, nausea, ability to stand, recovery, and what a witness saw.
Protect against falls
Use lighting, hand support, slower position changes, and help on stairs or in showers when symptoms are active. Do not drive during unpredictable disabling vertigo.
Keep medicines and timing visible
Record every medicine, dose time, missed dose, alcohol, poor sleep, migraine, infection, and menstrual or other timing that coincided with attacks.
Use rehabilitation only after the diagnosis is clear
Vestibular rehabilitation can help selected disorders, but exercises and repositioning maneuvers should match the diagnosis and physical safety assessment.
Do not repeatedly provoke vertigo, perform forceful head movements, stop prescriptions, or copy internet maneuvers when the diagnosis and neck safety are uncertain. Sudden severe vertigo with new weakness, speech trouble, double vision, inability to walk, or severe headache needs urgent care.
What should you keep from a vestibular assessment?
Keep these together
- Two typical episode descriptions
- Medicines and exact last dose
- Hearing test and ear symptoms
- VNG or ENG components and nystagmus findings
- Positional tests and symptom match
- Caloric side, responses, and asymmetry
- vHIT canal gains, saccades, device, and artifacts
- VEMP method and responses
- Rotary-chair frequencies and interpretation
- Posturography or gait findings and fall safety
- Tests not completed and why
- Signed impression, diagnosis status, and next plan
Question for the visit
“Show the whole pattern and the parts of the system that were not tested.”
Sources for Vestibular Assessment
US patient overview of balance causes, specialist roles, and vestibular test types.
Patient procedure detail for VNG, calorics, rotary chair, vHIT, VEMP, and posturography.
Systematic review of EyeSeeCam vHIT normative data and device-specific limits.
Meta-analysis of caloric and vHIT patterns in Meniere disease and vestibular migraine.
See each claim's sources
procedure
NIDCD describes vestibular assessment as a possible combination of hearing, VNG, posturography, rotary chair, head movement, and sound-evoked response tests.range
Moreno Valencia 2026 found wide, system-specific vHIT gain ranges across nine EyeSeeCam studies and 404 healthy adults.interpretation
Vosbeek 2025 pooled 21 studies and 3,096 people and found caloric and vHIT abnormalities more common in Meniere disease than vestibular migraine.context
A two-center study found vestibular loss in 44% of selected children with sensorineural hearing loss and better accuracy from combined testing than from one test alone.